North West buddy scheme

Teaming junior doctors with junior managers can break down the professional divide, argue Yasmin Ahmed-Little, Stuart Holmes, and Benjamin Brown

Growing clinical leaders

Ara Darzi’s “next stage review” recently called for better clinical leadership in the NHS in England, and a growing body of evidence has demonstrated how this helps organisations to perform better.[1][2][3][4][5] Having run leadership initiatives for junior clinicians in the North West region over the past nine years,[6][7] we were aware that simply providing development in leadership skills was not enough. After overcoming the fear and apprehension of colleagues, junior doctors consistently blamed “managers” for lack of progression with their ideas to improve care. To have any chance of success, we needed to equip our junior doctor colleagues with the ability to understand, influence, and engage managers in their own organisations.

Behind enemy lines

Do healthcare managers seek to shoot down the next enthusiastic junior doctor who crosses their path? More and more we found clinicians were not even trying to engage with managers because they anticipated a negative response. Even if they overcame this fear of rejection, most did not know where to begin a conversation with the management community—where to find them, what they looked like, what approach to take, or even what language to use. Rumours created a vicious cycle that seemed impossible to overcome.

On the other side of the coin, we had increasing exposure to the NHS management training scheme (MTS), the programme that trains graduates to become NHS managers. We noticed that, unintentionally, the training sometimes included references to the “difficult consultant” and how to manage conflict with clinicians, before the graduates had even met their first real life doctor. This build up of tension between trainee managers and doctors perpetuated stereotypes, guaranteeing that future encounters remained intimidating and unsatisfactory for both.

We ran an annual session at the MTS induction on doctors and managers to help set the scene. To our surprise, the management trainees were eager to meet clinicians as early as possible, to learn for themselves what doctors are really like and how best to work together. They just had no idea how to make this introduction, let alone hope to receive a warm welcome. Surely there was something we could do to help?

Why break down barriers when you can prevent them from being built in the first place?

Attempts to bring together doctors and managers in the NHS have focused predominantly on senior staff. Intuitively it made sense to explore such links earlier in training. Instead of breaking down well established and stubborn barriers, it made more sense to prevent barriers from being built in the first place.

What did we do?

The North West buddy scheme is a pilot of the first national junior doctor-junior manager pairing scheme. Launched in January 2010, it is led by the North West emerging clinical leaders network, which is run by and for emerging clinical leaders.[8] The scheme links junior clinicians with MTS trainees in the north west of England in buddy pairs. Currently there are more than 80 “buddies” and a waiting list for new participants to join the scheme. Buddy pairs are allocated regular, virtual, specific, measurable, achievable, relevant, time-specific (SMART) tasks,[9] the aim of which is to tackle real issues from the two different perspectives and learn from each other’s approaches. The virtual nature of the tasks allows otherwise busy professionals to participate and benefit from the scheme without feeling pressured (box 1). Opportunities to meet face to face outside the tasks are also available via informal networking drinks and dinners. Outcomes from the tasks are shared as widely as possible and appropriately to ensure maximum benefit.[7][10]

Our vision

The buddy scheme aims to achieve cross-fertilisation between emerging managerial and clinical leadership programmes from the beginning of training. We not only hope to challenge existing stereotypes of managers and clinicians, but prevent them from being created in the first place. Better understanding at an early stage of training should lead to better relationships in the future, with benefits for service delivery and ultimately the patients of the NHS. Individuals within the scheme have also benefited from the relationships they have built with their buddies, providing an invaluable resource of trusted managerial or clinical insight and expertise, which will hopefully continue for years to come.[11]

Box 1: Buddy tasks to date

Task 1. Dear Deidre problem page letters

Buddies were asked to write 100 word problem page letters to each other, outlining an issue they had faced with a clinician or manager. Their partner then issued a 100 word response from their own perspective.

Task 2. Virtual shadowing

Buddies were asked to agree a day in a specified week where they would document their activities and then share their findings and reflections with the wider group.

Task 3. Problem based learning cases

Buddies were given a selection of three possible leadership based, problem based learning cases and asked to work together to create a joint response to the various issues raised. Areas covered included four hour waits in accident and emergency, implementing local change, and Hospital at Night. Each problem based learning case was mapped to the appropriate medical leadership competency framework or NHS leadership qualities framework competences that could be achieved.[12][13]

Task 4. “If I ran a consortium” exercise

The current task requires buddies to consider what their top five thoughts would be if they were to run a consortium, firstly as individuals and then working with their buddies to agree a shared top five. Pairs will then be matched with local consortium experts, which leads to discussion and reflection on their thoughts.

How can I get involved?

If you are based in the North West region and want to get involved or know more, please get in touch ( nwbuddyscheme@gmail.com). We are also aware of other regions that have since established similar programmes (box 2).

Box 2: How to set up a buddy scheme

First steps

One of the key strengths of a buddy scheme is that it requires no resources other than a dedicated coordinator. Correspondence with your buddies can be time consuming, however, so it is important to select someone with the capacity to keep on top of this.

Set up an email address (for example, Gmail) for your scheme that can be directed to the smart phones of all the scheme administrators. This will prevent emails from buddies from being overlooked and will provide an accessible online space to hold the contact details of your cohort.

When establishing your scheme, think carefully about your audience. It is best to work with junior management trainees and clinicians with little management experience. More senior buddies with a lot of management experience can become jaded by the simpler tasks that are appropriate for the more naive participants.

Making buddies

Recruit new management trainees by making links with the administrators of the NHS management training scheme in your region.

Junior clinicians can be reached via deanery mailshots (for doctors) or with the help of workforce leads at the strategic health authority. Clinical leadership websites and newsletters are another good way to recruit.

Use a Survey Monkey questionnaire to register people. This allows you to capture (and export in a tabular format) names, contact details, and information about location, specialty, and grade.

You can then use this information to match people and make relevant partnerships, for example linking psychiatry trainees with managers in a mental health trust or buddies from the same trust or geographical area.

If working with specialty management trainees (for example, from information technology and finance), consider making buddy trios so that each partnership can include a general management trainee.

Buddies will invariably go AWOL before, during, and after tasks. Bear this in mind and be attentive to the emails of jilted participants.

Tasks

Keep tasks simple and current (for example, relate them to the current NHS reforms). Use realistic scenarios that the buddies are likely to find themselves in.

Tasks must be designed so that buddies can work remotely and in their own time.

Map the intended learning outcomes of each task to the leadership qualities framework and medical leadership competency framework; buddies can then use the scheme for their portfolios.

Craft emails outlining the details of each task extremely carefully—emphasise the minimal time commitment required by a task to encourage timely completion. Two minutes spent on a well composed email will save hours further down the line in pre-empted queries.

Outputs

Pull together the learning points to be taken from the buddies’ responses to each task to give feedback to the cohort.

Facilitate deeper cross professional relationships by organising events such as face to face networking events as well as inviting management trainees to local clinical leadership events.

There’s no reason why you can’t do something similar yourself. Joining the Network (www.the-network.org.uk) will allow you to search for potential managerial buddies, because several are already members. Alternatively you could seek a management buddy in your own organisation, either via your local human resources director or by contacting the NHS Institute directly. One of the main advantages of our scheme is that it requires very little resources other than time to run the programme itself and commitment from participants. Within the current financial climate, this scheme is innovative, sustainable, and can ultimately improve the quality of future care in the NHS for no tangible cost.

KISS—Keep it simple, stupid

“KISS” is a basic principle often overlooked in the NHS. One of the reasons for the success of this pilot—other than the fact that it’s free—has been its simplicity. If you are looking to set up something similar yourself, make it easy to do. Tasks should allow for a realistic commitment from buddies but ensure time invested is still worthwhile. A virtual programme allows more effective use of time, and we have yet to explore the potential use of free telecommunications such as Skype (www.skype.com/intl/en-gb/home). There is an existing bank of materials already available from our previous tasks that you can use, as well as examples of previous outputs.[7][10]

The future

We hope to continue with the programme for many years, although thinking of appropriate tasks is not always easy, and new ideas are always welcome. Evaluation is ongoing (box 3), and with more regions exploring similar programmes there are further links to be made. As the scheme becomes more established we will explore the benefits of “double dating” with other buddy pairs within and outside the North West.

Box 3: Feedback from participants

Managers

“I want to know more about the day to day things that clinicians do. I am based in a primary care trust and have little contact with frontline clinicians or junior doctors. I would like to know more about the challenges they face”

“Having the opportunity to discuss openly the differences between clinicians and managers to gain better understanding of each other’s professions was helpful”

“I do think it is an excellent initiative, particularly from the MTS perspective of the insights we can gain from our clinical buddies”

“I would recommend it for my staff as a method of seeing others’ perspective” (task 1)

“It was interesting to gain an insight into the lives of clinicians” (task 2)

Clinicians

“Really good to meet on neutral ground and find out about the management training scheme”

“Interesting to see views from the other side, and I can see how having this link would really help with problem solving in the future and removing prejudices”

“It was useful to discover the problems managers have with clinicians and that a lot of this comes down to poor communication”

“Opportunity to find out what junior managers are like compared with junior clinicians”

“Useful scheme and lends itself to being manageable in the field of work-life and limited time”